Sequestrectomy with additional transpedicular dynamic stabilization for the treatment of lumbar disc herniation - No clinical benefit after 10 years follow-up.

MedLine Citation:

PMID:
23232214
Owner:
NLM
Status:
Publisher

Abstract/OtherAbstract:

ABSTRACT: Study Design: Single-center prospective study.Objective: Clinical and radiological long-term evaluation of the effects of transpedicular dynamic stabilization after sequestrectomy.Summary of Background Data: Short- and mid-term investigations have shown that additional dynamic stabilization is appropriate to prevent progression of initial segment degeneration after sequestrectomy and associated with superior clinical outcome compared to sequestrectomy alone. Long term data are missing.Methods: 84 patients with symptomatic disc herniation and initial osteochondrosis (Modic = I°) of the lumbar spine underwent sequestrectomy. Additional dynamic stabilization was performed in 35 subjects (group D), the remaining 49 subjects were treated with sequestrectomy alone (group S). Clinical (ODI, VAS) and radiological (plain, extension-flexion X-ray, MRI) parameters were collected preoperatively, at 3 month postoperatively as well as at a mean follow-up of 2.8 and 10.2 years.Results: 29/35 (83%, group D) and 38/49 (78%, group S) patients were available at the final follow-up. Reoperation rate in group D was 10/29 (34%) due to implant failures or progression of degeneration at the index or the adjacent segments. In group S 5/38 (13%) underwent further operation because of a re-prolapse or progression of degeneration of the index level. In the remaining patients clinical scores (ODI and VAS) improved significantly with similar results in both groups at the final follow-up. The rate of progression of disc degeneration was lower when the patients were additionally dynamically stabilized compared to sequestrectomy alone, but the rate of adjacent segment degeneration superior to the operated segment was significantly higher in group D.Conclusion: Additional dynamic stabilization does not lead to a clinical benefit in patients with symptomatic disc herniation and initial segment degeneration compared to sequestrectomy alone after a long-term follow-up. Because of this and the high rate of necessary reoperations we do not recommend this surgical strategy for this indication.